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Efficacy and Safety of Segmental Ostial Versus Circumferential Extra‐Ostial Pulmonary Vein Isolation for Atrial Fibrillation
Author(s) -
MANSOUR MOUSSA,
RUSKIN JEREMY,
KEANE DAVID
Publication year - 2004
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2004.03503.x
Subject(s) - medicine , pulmonary vein , atrial fibrillation , ablation , cardiology , catheter ablation , implantable loop recorder , isolation (microbiology) , microbiology and biotechnology , biology
Pulmonary vein (PV) isolation for atrial fibrillation (AF) can be performed using a segmental ostial or a circumferential extra‐ostial approach. The relative merits and potential limitations of each approach are currently debated. Here we report our early experience with each of these approaches, including their relative efficacy and safety. Methods and Results: Forty patients with drug‐refractory AF underwent segmental ostial PV isolation and were compared to 40 consecutive patients who underwent PV isolation using a circumferential extra‐ostial approach. The latter approach described here is novel in two aspects: (1) the endpoint for ablation was PV isolation and not only delay in left atrial to PV conduction time, and (2) isolation of the right and left PVs was achieved by a single encirclement of ipsilateral veins. At follow‐up, 60% of the patients in the segmental group were free of AF compared to 75% of the patients in the circumferential group. There was one thromboembolic cerebrovascular complication during the ablation procedure in each group. Conclusion: PV isolation using a circumferential extra‐ostial approach, where the ipsilateral PVs are isolated together by one encircling line of block using electroanatomic mapping, is a technically feasible procedure. This approach is at least as effective and safe as the more established segmental ostial approach for AF ablation. (J Cardiovasc Electrophysiol, Vol. 15, pp. 532‐537, May 2004)